A retrospective study to assess the morbidity associated with transurethral prostatectomy in patients on antiplatelet or anticoagulant drugs

• Published in: BJU international Vol. 108; no. s2; pp. 45 - 50
• Main Authors: Taylor, Kellie, Filgate, Rhys, Guo, Ding Yu, Macneil, Finlay
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2011; Wiley Subscription Services, Inc
• Subjects: Aged; anticoagulant; Anticoagulants; Anticoagulants - therapeutic use; antiplatelet; aspirin; Aspirin - therapeutic use; Blood Loss, Surgical - prevention & control; Blood Loss, Surgical - statistics & numerical data; Cardiovascular Diseases - etiology; Case-Control Studies; Cerebrovascular Disorders - etiology; Humans; Male; Medical research; Morbidity; Perioperative Care - methods; Platelet Aggregation Inhibitors - therapeutic use; Prostatic Hyperplasia - surgery; Prostatic Neoplasms - surgery; Retrospective Studies; Transurethral Resection of Prostate - adverse effects; transurethural prostatectomy; warfarin; Warfarin - therapeutic use
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10686.x

What's known on the subject? and What does the study add? There is controversy over the use of anti‐platelet and anti‐coagulant drugs in men undergoing TURP with contradictory evidence on the effect of the drugs on bleeding following the operation, particularly for aspirin. If anti‐platelet or anti‐coagulant drugs are not stopped for TURP, there is an unacceptable burden of bleeding. If the drugs are stopped there is an unacceptable rate of cardiovascular events. OBJECTIVE •  To determine the morbidity associated with perioperative management of antiplatelet (AP) or anticoagulant (AC) medication and transurethural prostatectomy. PATIENTS AND METHODS •  A retrospective review was performed on 163 consecutive patients undergoing transurethural prostatectomy. •  Patients were grouped according to the perioperative management of AP and AC medications: control patients not prescribed any AP/AC drugs (group 1), those on AP/AC who had ceased them perioperatively (group 2) and those whose AP/AC were continued (group 3). •  Warfarin was withheld perioperatively for all patients. •  Morbidity associated with increased blood loss and cardiovascular or cerebrovascular events was recorded and differences were analysed with SPSS version 16 software. RESULTS •  There was a statistically significant increase in bleeding‐associated morbidity in group 2 (13/65) and group 3 (6/7) compared with the controls (9/91) (P < 0.01). •  Cardiovascular and cerebrovascular events were only seen in group 2 (6/65), statistically significantly higher than the event rate in the other groups (P≤ 0.01). •  All cardiovascular or cerebrovascular events occurred in patients prescribed these medications for secondary prevention. CONCLUSION •  Patients taking AP or AC medications have a higher rate of perioperative bleeding compared with those who are not taking any. •  However, for patients prescribed AP or AC medication for secondary prevention, withholding these medications results in an increased rate of cardiovascular and cerebrovascular complications. •  Careful consideration of the risks and other management options should be undertaken before performing transurethural prostatectomy in this high risk group of patients.